b) Treatment

Pain medications on their own, even prescription ones, are seldom effective in managing the discomfort associated with a dry socket.

The most effective treatment is one where the patient's dentist inserts a medicated dressing (daily if needed) directly into the wound. In a pinch, there are some home remedy methods that can be used to provide pain relief.

c) Risk Factors / Prevention

Research and clinical observation have identified a number of factors that correlate with a patient's risk for developing a dry socket. Understanding these factors can be useful in preventing their formation.

The blood clot that begins to form immediately after an extraction is an important part of the healing process.

Etiology - Why do dry sockets form?

The exact pathogenesis of dry socket formation is not fully understood but it is known that the following factors are involved.

1) The blood clot is lost.

A course of events takes place where the blood clot that normally forms in a tooth's socket following its removal isn't properly retained. It either:

Disintegrates by way of a chemical process termed fibrinolysis.

(Fibrin is a tough fibrous protein whose formation is triggered by the clotting process. Pieces join together to form long strands that then crosslink with others. As this process continues, and the web that's formed snares platelets, it develops into what's referred to as a blood clot.)

It's hypothesized that the compounds responsible for this fibrinolytic activity may come from the socket's bone itself, either as a consequence of infection or as a result of trauma created during the extraction process. (Noroozi)

Is dislodged by an event or activity.

(Common scenarios involve loss of the clot as a result of vigorous swishing or rinsing, or the creation of a sucking action, like when drinking using a straw.)

2) Healing is delayed.

The lost blood clot would have played an important role in the healing process of the extraction site. However, due to its loss the progress of the socket's healing is interrupted (delayed).

If the blood clot is lost, the socket's bony interior is exposed instead of protected.

3) Bone becomes exposed.

The clot would have also covered over and protected the bony walls of the empty socket as it heals. Now that it's been lost, the walls are exposed and become irritated, resulting in pain and sensitivity.

The signs and symptoms of dry sockets.

The key to being able to determine that you have a dry socket forming is to compare the symptoms you notice with what's normally expected with post-extraction healing.

a) What's the norm? What usually happens after a tooth is pulled?

In most cases a patient will notice some degree of pain from their extraction site on the day of their surgery. (Hopefully this will just be minor.)

And then with each day that follows, the level of discomfort they notice gradually tapers off until it finally disappears.

b) What happens when a dry socket starts to form?

With this scenario:

The patient will first find that their initial discomfort does gradually fade for the first few days following their extraction. (Just like with normal healing.)

But then, usually somewhere between days 2 and 4 after their procedure, their level of pain then begins to intensify.

While the exact timing of a person's symptoms will vary, 95% of dry socket cases are noticed within the first week after the patient's surgery.

1) Pain.

As just stated, the discomfort from the extraction site usually starts to intensify on day 2 to 4 after the tooth was initially removed (24 hours following the procedure, or later). This detail alone is an important clue to your dentist that you do in fact have a dry socket. Other characteristics are:

The discomfort is often (almost characteristically) described as a dull throbbing pain.

It can be moderate to severe in intensity, possibly even debilitating.

What's felt may be constant or intermittent. In the latter case, the frequency of onset can vary. Later on, the pain is more likely to be constant.

The pain may remain localized to just the extraction site, or it may radiate to other areas on the same side of the patient's head such as the ear or temple, or possibly even the eye or neck. Experiencing headaches is also reported.

The pain usually reaches its most intense level around 72 hours post-extraction (Bowe). The pain may be so debilitating that it causes loss of sleep and affects the person's daily function.

How long do dry sockets last?

Healing time frame.

Once the conditions of a dry socket have set in, it usually takes about 7 to 10 days for the healing process to get geared up again and create new granulation tissue that then starts to cover over and protect the socket's exposed bone. (Noroozi) [linked above]

How long will the pain last?

On average, the discomfort from a dry socket usually runs for 4 to 8 days. (That means, you'll likely need attention from your dentist to stay comfortable.)

At times the pain may be quite severe. Towards the end, it will just gradually taper off and disappear.

How long is the healing process delayed?

In general, you can expect that the overall healing time frame of your extraction site will be delayed on the order of a week or longer.

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Comments

pain at my surgical site

I made a bony impacted canine surgery where the doctor told me it was not an easy one and a lip repositioning one 7 days ago and the dentist told me that sutures should be taken off 2 weeks after the surgery .At the first 3 days the pain was not that much hard but at day four it started to become very painful and ubearable the pain radiates from my upper jaw at the surgical site to my teeth. I NEED TO KNOW THE REASON AND WHAT IS THE TREATNMENT PLZ ? and a last question is it normal to have swelling at one side of my lip at day 7 ? thank you

lynn

The only question we can give you much of an answer on is the swelling. In most cases, post-extraction swelling should start to subside around day 4. By day 7 it has usually resolved. In all cases, persistent swelling should be evaluated by your dentist.

As far as the cause of your pain, the timing of it and its "radiating pain" nature are reminiscent of a having dry socket. But as far as actually determining what your condition is, once again, you'll need to consult with your dentist. All dentists expect patients to contact them as complications develop, so you should take advantage of that and let them provide the attention you require.

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